Abstract
Simple SummarySurgery remains the mainstay treatment for oral cavity squamous cell carcinoma (OSCC). Up to 40% of patients with OSCC experience postoperative complications, most within the first 30 days since surgery. The early detection of postoperative complications is challenging. Sarcopenia has been shown to be a negative predictor of the surgical and oncological outcomes of patients with OSCC. The effect of sarcopenia associated with immediate complications and impaired survival after surgery for OSCC is still unknown. This study comprehensively investigated the clinical risk factors and biomarkers associated with 30-day postoperative complications and 5- and 8-year survival of patients with OSCC. Sarcopenia was an independent risk factor associated with 30-day complications, increased reoperation rate, and reduced short- and long-term overall and disease-free survival. Sarcopenia should be assessed before surgery to identify high-risk patients who require a more intensive approach to minimize complications and may be clinically helpful in tailoring treatment strategies for patients with OSCC.Sarcopenia negatively affects oncologic outcomes. However, studies have yet to reveal whether it is associated with postoperative complications and survival among patients with oral cavity squamous cell carcinoma (OSCC). This study retrospectively enrolled 592 patients undergoing primary OSCC surgery with available computed tomography (CT) images of their third cervical vertebrae (C3) within 30 days before surgery between January 2011 and December 2020. Preoperative sarcopenia, nutritional and frailty status, tumor characteristics, comorbidities, and inflammatory markers were assessed. The outcome variables included 30-day complications based on the Buzby and Dindo classification, reoperation, 5- and 8-year overall survival, and disease-free survival. A total of 318 (53.7%) had sarcopenia; of these patients, 217 (68.2%) presented with postoperative complications, and 48 (15.1%) underwent reoperations. Sarcopenia and higher systemic immune-inflammatory index were independently associated with local to systemic 30-day complications. Sarcopenia, advanced-stage disease, and extracapsular spread were correlated with 5- and 8-year survival. The presence of sarcopenia is associated with the 30-day complications and short- and long-term survival of patients who had OSCC and underwent surgery.
Highlights
Head and neck cancer (HNC) is the sixth most common cancer worldwide and can arise in the oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, thyroid, and salivary glands [1,2]
Patients who had available head and neck computed tomography (CT) images of the cervical vertebrae (C3) within 30 days before surgery were included in the analysis
The presence of sarcopenia was associated with elderly age (n = 62, 19.5%), a higher Charlson comorbidity index (CCI) (n = 225, 70.8%), advanced-stage disease, and a lower body mass index (BMI) (24.8 ± 3.0 kg/m2)
Summary
Head and neck cancer (HNC) is the sixth most common cancer worldwide and can arise in the oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, thyroid, and salivary glands [1,2]. Oral cavity squamous cell carcinoma (OSCC) accounts for 80–90% of malignancies of the oral cavity and arises in different anatomic subsites [2]. OSCC is resistant to standard chemotherapeutics, and surgery remains the main treatment [3]. Almost 40% of patients with this disease experience 30-day postoperative complications [4]. The early detection of postoperative morbidity and mortality is challenging. Patients with OSCC remain at high risks of recurrence and second primary tumors. Up to 65% of patients with HNC present with sarcopenia during the perioperative period [5]
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